BMJ Open Quality最新文献

{"title":"Interventions to increase utilisation of advanced care planning documentation for hospitalised older adults.","authors":"Laura E Walker, Anne Liwonjo, Deepi G Goyal","doi":"10.1136/bmjoq-2023-002703","DOIUrl":"10.1136/bmjoq-2023-002703","url":null,"abstract":"<p><strong>Objective: </strong>Understanding patients' wishes and preferences during hospitalisation is a crucial component of care. We identified a gap related to documentation of advance directives and patient preferences for care and focused on ensuring appropriate goals of care discussions were occurring and documented. Our aim was to improve the documentation of advance care planning notes to include 80% of targeted hospitalised patients.</p><p><strong>Patients and methods: </strong>Hospitalised patients in two community hospitals were included. We performed serial Plan-Do-Measure-Act cycles. The first intervention introduced the 'surprise question' during an afternoon huddle. Intervention 2 emphasised documentation of the advance care planning note. The third intervention used a structured approach led by administrators at daily multidisciplinary huddles and identified patients with an Elderly Risk Assessment score of 16 or greater as targets for advance care planning documentation.</p><p><strong>Results: </strong>From a baseline performance under 10%, we increased to greater than 80% of patients with Elderly Risk Assessment scores of 16 or higher having documented advance care planning. We were able to sustain this performance over subsequent years.</p><p><strong>Conclusion: </strong>A structured approach that identifies a targeted population at higher risk of mortality, and implementation of a checklist at a daily multidisciplinary huddle provided sustained improvement in advance care planning documentation. This provides the opportunity for improved patient care that is aligned with their values and preferences.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the REDS score in hospitalised patients who deteriorated and were admitted to the intensive care unit-a retrospective cohort study.","authors":"Narani Sivayoham, Harriet O'Mara, Natasha Trenchard Turner, Katie Sysum, Georgina Wicks, Oliver Mason","doi":"10.1136/bmjoq-2024-003054","DOIUrl":"10.1136/bmjoq-2024-003054","url":null,"abstract":"<p><strong>Background: </strong>Hospitalised patients are at risk of deterioration and death. Delayed identification and transfer to the intensive care unit (ICU) are known to be associated with increased mortality rates. The Risk-stratification of Emergency Department suspected Sepsis (REDS) score was derived and validated in emergency department patients with suspected sepsis. It is unknown if the REDS score would risk-stratify undifferentiated hospitalised patients who deteriorate.</p><p><strong>Objectives: </strong>To validate the REDS score in hospitalised patients who deteriorate.</p><p><strong>Methods: </strong>This retrospective cohort single-centre study involved hospitalised adult patients who deteriorated and were transferred to the ICU between 1 April 2022 and 31 March 2023. The first admission to the ICU was studied. The National Early Warning Score2 (NEWS2), REDS, Sequential Organ Failure Assessment (SOFA) and change-in-SOFA (ΔSOFA) scores were calculated at the time of referral to the Critical Care Outreach Team (CCOT). The primary outcome measure was in-hospital all-cause mortality. The area under the receiver operator characteristic (AUROC) curves for the scores were compared. Test characteristics at the cut-off points individually and in combination were noted.</p><p><strong>Results: </strong>Of the 289 patients studied, 91 died. The REDS score had the largest AUROC curve at 0.70 (95% CI 0.65 to 0.75), greater than the NEWS2 score at 0.62 (95% CI 0.56 to 0.68), p=0.03, and similar to the SOFA score 0.67 (95% CI 0.61 to 0.72), p=0.3. The cut-off points for the NEWS2, REDS, SOFA and ΔSOFA scores were >9, >3, >6 and >4, respectively. The sensitivity and specificity for a ΔSOFA≥2 was 91.2% (95% CI 83.4 to 96.1) and 15.7% (95% CI 10.9 to 21.5), respectively. REDS≥4 or NEWS2≥7 had a sensitivity of 87.9% (95% CI 79.4 to 93.8) and specificity of 29.3% (95% CI 23.1 to 36.2).</p><p><strong>Conclusion: </strong>The prognostic performance of the REDS score was similar to the SOFA score, but greater than the NEWS2 score. The REDS score could be used in addition to the established NEWS2 score to risk-stratify hospitalised patients for mortality.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NCHD handover in the acute mental health setting: a quality improvement initiative implementing an electronic handover tool.","authors":"Stelios Naxakis, Megan Wafer, Syeda Gardezi, Aamina Sadia, Rimsha Mujahid, Karen O'Connor","doi":"10.1136/bmjoq-2024-002978","DOIUrl":"10.1136/bmjoq-2024-002978","url":null,"abstract":"<p><strong>Background: </strong>Cork University Hospital, Ireland's largest teaching hospital, faced challenges in maintaining consistent handover processes in its Acute Mental Health Unit (AMHU). Prior to 2019, handovers relied on informal methods, risking information loss and compromising patient care. This quality improvement (QI) initiative aimed to standardise handover practices using an electronic tool integrated with the ISBAR communication protocol.</p><p><strong>Objectives: </strong>The project aimed to ensure accurate clinical information recording, improve patient care and safety, centralise handover material, enhance clinical transparency and accountability, and measure handover quality using the electronic tool.</p><p><strong>Methods: </strong>Using a Plan-Do-Study-Act (PDSA) model, the initiative began with a critical incident in July 2020, prompting the creation and piloting of an electronic 'handover tool' aligned with ISBAR. Subsequent PDSA cycles included mandatory policy implementation and educational interventions to reinforce tool usage and adherence to communication standards.</p><p><strong>Results: </strong>The electronic handover tool improved handover practices, with increased compliance to recommended criteria and enhanced tool utilisation. Notable improvements followed targeted educational interventions, leading to more comprehensive and standardised handover entries. These improvements enhanced communication and information transfer among NCHDs, contributing to better continuity of care and patient safety.</p><p><strong>Conclusions: </strong>The QI initiative successfully standardised handover processes and improved communication among NCHDs in the AMHU. While improvements were observed, ongoing efforts are needed to address challenges and sustain effectiveness. Continuous training, feedback mechanisms and further refinement of the handover tool are essential for long-term success. Future directions include exploring additional technological solutions and reinforcing a culture of effective communication.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world evaluation of physiotherapist-led exercise prehabilitation and rehabilitation during autologous stem cell transplantation in myeloma: a single-centre experience.","authors":"Joanne Land, Michael K Luong, Alasdair Longden, Neil Rabin, Charalampia Kyriakou, Jonathan Sive, Abi Fisher, Kwee Yong, Orla McCourt","doi":"10.1136/bmjoq-2024-002936","DOIUrl":"10.1136/bmjoq-2024-002936","url":null,"abstract":"<p><strong>Background: </strong>There is emerging evidence for the role of exercise in optimising function, quality of life (QoL) and reducing hospital length-of-stay if commenced prior to undergoing autologous stem cell transplantation (ASCT). A local pilot study of a prehabilitation and rehabilitation intervention during ASCT for myeloma patients indicated promising results and was adapted to translate into local clinical care. The aim of this report is to describe an overview of a newly implemented physiotherapist-led exercise prehabilitation and rehabilitation service delivered as part of the myeloma ASCT pathway, and present real-world findings related to changes in function and QoL.</p><p><strong>Methods: </strong>A service evaluation was conducted at a single-centre tertiary referral hospital for haematopoetic stem cell transplantation in the United Kingdom. A hybrid service using face-to-face clinical assessments and weekly remotely supervised group exercise, via an online video conferencing platform, in the phase between stem cell harvest and admission (prehabilitation), and from discharge to 100 days post-ASCT (rehabilitation). Functional (6 min walk and timed sit-to-stand tests) and patient-reported outcome measures (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-C30) and EuroQol EQ5D-5L were assessed at preharvest, preadmission and in the post-ASCT evaluation (day 100) clinic.</p><p><strong>Results: </strong>Patients (n=46) with a diagnosis of multiple myeloma referred for ASCT following induction chemotherapy were assessed. Baseline assessments showed high prevalence of impaired function and lower limb strength. Improvements were evident following prehabilitation prior to admission, which were maintained post-ASCT. Changes in 6 min walk test and timed sit-to-stand were significant and beyond thresholds of clinical importance. Improvements were also seen in the domains of QoL.</p><p><strong>Conclusions: </strong>Implementation of physiotherapist-led assessments in the myeloma clinic and group exercise delivery under remote supervision are acceptable to patients undergoing ASCT and indicate benefit in improving function and QoL.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the evaluation of non-accidental trauma across multiple specialties at a single institution.","authors":"Lani Kroese, Courtney Port, William Hauda","doi":"10.1136/bmjoq-2024-002953","DOIUrl":"10.1136/bmjoq-2024-002953","url":null,"abstract":"<p><strong>Background: </strong>Based on the presenting injury, patients undergoing abuse evaluation may be managed by different specialties. Our local child abuse specialist expressed concern over the variability in evaluation of patients presenting with injuries concerning for non-accidental trauma (NAT). The aim of this quality improvement project was to increase the percentage of patients for whom there is a concern for NAT who receive a guideline-adherent evaluation from 7.7% to 50% in 6 months' time.</p><p><strong>Methods: </strong>A committee of physician stakeholders developed criteria for a complete NAT evaluation which were integrated into an order panel with built-in clinical guidance for test selection within our electronic medical record. Data on the completeness of NAT evaluation in paediatric patients 0-18 years of age were collected before and after the order panel release and analysed by admitting service, injury category and equity factors.</p><p><strong>Results: </strong>This initiative increased the percentage of patients with a guideline-adherent evaluation from a mean of 7.7% to 25% within 6 months' time. The number of days between patients with complete evaluations decreased from 63 days to 35 days. Order panel utilisation increased to 55%, and the percentage of evaluation opportunities was more complete when the order panel was used (79% vs 92%).</p><p><strong>Conclusions: </strong>Standardisation of NAT evaluations through creation of an order panel with a clinical decision tool resulted in more guideline-adherent evaluations. The potential reduction of bias in such evaluations remains an area of interest.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement on reducing neonatal mortality through intensive Clinical Mentorship Intervention: a case study in Biak Regional Hospital, Papua-Indonesia.","authors":"Windhi Kresnawati, Liza Froulina, Bobby Marwal Syahrizal, Nurlely Bethesda Sinaga, Edit Oktavia Manuama, Rinawati Rohsiswatmo, Setya Wandita","doi":"10.1136/bmjoq-2024-002862","DOIUrl":"10.1136/bmjoq-2024-002862","url":null,"abstract":"<p><strong>Background: </strong>The neonatal mortality rate in Papua Province of Indonesia is unacceptably high. To address the issue, the Ministry of Health and UNICEF Indonesia initiated a hospital mentoring programme from 2014 to 2016 to improve the quality of care and health workers' capacity to provide neonatal care. This study aimed to assess the impact of hospital mentoring on neonatal mortality.</p><p><strong>Methods: </strong>The study was conducted at Biak District Hospital, Indonesia. The neonatal mortality was compared for three periods: preintervention (2011-2013), mentorship intervention phase (2014-2016) and postintervention (2017-2020). The mentoring programme is a combination of a direct-intensive-regular mentoring process and a scholarship programme for paediatricians. In the mentoring process, paediatricians, neonatal nurses and electromedical staff from national hospitals were sent to train the nurses on nursing management for sick neonates, clinical neonatal resuscitation, stabilisation and transportation. The neonatal mortality data were collected from birth registers, medical records, death case review reports and mentoring programme reports.</p><p><strong>Results: </strong>A significant decrease in the percentage of death cases before 24 hours of hospitalisation and death cases due to asphyxia was observed in the three periods. In the death cases from referrals, a significant decrease from 70% in the intervention period to 39.7% in the postintervention period was observed (p<0.05). The survival rate of neonates with body weights under 1500 g and 1500-2500 g was compared in the intervention and postintervention period, a significant increase from 21% to 58% and 55% to 94% was observed, respectively (p<0.05).</p><p><strong>Conclusion: </strong>The direct-intensive-regular mentoring intervention programme was found to be effective in reducing neonatal mortality through quality improvement in low-resource district hospitals.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality indicators and development targets in the national clinical quality registries in cancer care and screening.","authors":"Amalie Helme Simoni, Lina Marie Vinge Ahlstrøm, Anne Gulbech Ording, Lene Hjerrild Iversen, Søren Paaske Johnsen, Jens Winther Jensen, Henrik Møller","doi":"10.1136/bmjoq-2024-003019","DOIUrl":"10.1136/bmjoq-2024-003019","url":null,"abstract":"<p><strong>Background: </strong>The Danish clinical quality registries monitor and improve the quality of care, using quality indicators and defined development targets referred to as 'standards'. This study aims to investigate the fulfilment of standards in the Danish clinical quality registries in cancer care and screening.</p><p><strong>Methods: </strong>Data was included from annual reports in the 27 Danish clinical quality registries in cancer care and screening. The most recent report from each registry was downloaded the 13 December 2023. Indicators were included if: evaluating care or screening over 12 months, presenting a well-defined standard with a desired direction and presenting the proportion and number of individuals for which the standard was fulfilled. Data were extracted on national and regional levels for the last 3 years, and fulfilment of standards was presented as the proportion of indicators that fulfilled the standard within each unit of comparison.</p><p><strong>Results: </strong>In total, 216 quality indicators were included. At the national and regional level, standards were fulfilled for 75% and 71%, respectively. Fulfilment within the registries varied from 5% to 100% on national and 12% to 99% on regional level. Standards were more often fulfilled for result (than process indicators) and for established (than supplemental indicators). Altogether, 43% of the standards were fulfilled across all regions delivering data for the specific indicator.</p><p><strong>Conclusions: </strong>The approach to defining standards for clinical quality indicators as conservative minimum or ambitious development targets varied in the Danish clinical quality registries in cancer care and screening. This deviating behaviour seriously restrains possibilities for comparing clinical quality across cancers despite the robust infrastructure of the quality registries, limiting the possibilities for overview and prioritising resources and attention to the most urgent cancers.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis.","authors":"Lin Yang, Peng Xiang, Guifang Pi, Ting Wen, Li Liu, Dan Liu","doi":"10.1136/bmjoq-2024-003037","DOIUrl":"10.1136/bmjoq-2024-003037","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to assess the effectiveness of nurse-led care (NLC) in patients with rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>We conducted a comprehensive search of the Cochrane Library, Web of Science, PubMed, Embase, CINAHL, ClinicalTrials.gov databases and the references from relevant literature published prior to May 2023. Two independent reviewers assessed the studies using population/intervention/comparison/outcome/study criteria, and quantitative tools were used to gauge the methodological quality of the included studies. Independent quality assessments were carried out using the Cochrane Collaboration's risk-of-bias tool. Effect sizes were determined using mean difference (MD) or standardised mean difference (SMD) with corresponding 95% CIs.</p><p><strong>Results: </strong>Ultimately, 14 articles were included, encompassing a total of 3369 RA patients. NLC exhibited significant advantages in the primary outcome, disease activity (MD =-0.09, 95% CI (-0.17 to -0.01)), and the secondary outcome, self-efficacy (MD=0.40, 95% CI (0.03, 0.77)). In subgroup analysis, NLC was more effective in reducing disease activity compared with usual care (MD=-0.15, 95% CI (-0.26 to -0.04)), and there was no significant difference in disease activity reduction between NLC and rheumatologist-led care (MD=-0.02, 95% CI (-0.14, 0.10)). In terms of self-efficacy, no significant difference was observed between NLC and usual care (SMD=0.56, 95% CI (-0.09, 1.21)) or between NLC and rheumatologist-led care (SMD=0.20, 95% CI (-0.19, 0.59). When comparing other secondary outcomes (pain, satisfaction, quality of life, fatigue, stiffness, physical function and psychological status), the effectiveness of NLC for RA patients was similar to that of the control group, with no statistically significant differences.</p><p><strong>Conclusions: </strong>NLC proves highly effective in managing RA patients, surpassing usual care and equating to rheumatologist-led care in primary and some secondary outcomes. It may be feasible to allow nurses to participate in the disease management of some RA patients instead of doctors.</p><p><strong>Prospero registration number: </strong>CRD42022362071.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of providing at-home opioid disposal kits at discharge after an orthopaedic surgery.","authors":"Eric Shan, Ruiying Xiong, Michael Katzman, Zarina Ali, Daniel Lee, M Kit Delgado, Anish Agarwal","doi":"10.1136/bmjoq-2024-003040","DOIUrl":"10.1136/bmjoq-2024-003040","url":null,"abstract":"<p><p>Prescription opioids after surgery may pose a risk if left unused. However, prescribers rely on their best judgement in determining how much their patients need, often resulting in over-prescription of these medications. Opioid disposal is a strategy to reduce the risk of persistent use or misuse of opioids. At-home disposal kits allow patients to safely dispose of leftover opioids. In this study, we assess the impact of opioid disposal kits on disposal rates after orthopedic surgery. In a difference-in-differences study of 1,321 eligible patients, disposal kits were associated with a 10.6 percentage point increase (95% CI: -3.5% to 24.7%) in disposal rates as well as a 10.5 percentage point increase (95% CI: 0.2% to 20.9%) in the fraction of opioids disposed. We build on prior research and identify that providing surgery patients with an opioid disposal kit at the time of discharge increases their self-disposal rates.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report.","authors":"Ibrahim Alghamdi, Lisa Brunton, Christopher Ashton, David A Jenkins, Adrian R Parry-Jones","doi":"10.1136/bmjoq-2024-002954","DOIUrl":"10.1136/bmjoq-2024-002954","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of mortality and morbidity, demanding prompt and accurate identification. However, prehospital diagnosis is challenging, with up to 50% of suspected strokes having other diagnoses. A prehospital video triage (PHVT) system was piloted in Greater Manchester to improve prehospital diagnostic accuracy and appropriate conveyance decisions.</p><p><strong>Method: </strong>A service evaluation of a PHVT pilot was conducted to assess PHVT efficacy and identify facilitators and barriers. The pilot (October-December 2022) was a collaboration between the North West Ambulance Service, Greater Manchester Neurorehabilitation and Integrated Stroke Delivery Network and stroke clinicians at Salford Royal Hospital. The service evaluation was mixed methods, including qualitative semistructured interviews with stroke clinicians, paramedics and patients (and/or caregivers). Interviews were analysed using a thematic approach.</p><p><strong>Results: </strong>Out of 46 PHVT calls during the pilot, eight (18%) were diverted to local emergency department, 1 (2%) was left at their usual residence and 37 (80%) were transported to Salford Royal Hospital. Final diagnosis for PHVT patients was stroke in 15 (33%) of cases, non-stroke in 20 (43%) and transient ischaemic attack in 11 (24%).Patients/caregivers found PHVT beneficial in directing them to appropriate hospitals and streamlining admission and treatment. However, some reported delays as a result. Clinicians expressed mixed opinions regarding PHVT's utility. Paramedics found PHVT improved confidence in managing stroke patients. Hospital clinicians believed it provided valuable prearrival patient information, enhancing preparation. Others found PHVT less effective due to on-scene delays, challenges conducting comprehensive assessments over video and inability to identify all non-stroke cases.</p><p><strong>Conclusion: </strong>PHVT was viewed favourably by most patients for enhancing the care quality. Paramedics and hospital clinicians acknowledge PHVT's support in making appropriate conveyance decisions and improving the preparation process before the patient's arrival. Participants, however, suggested prearrival registration, 24-hour availability and clinicians' buy-in for a more effective future rollout.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}